What Is A Nuchal Cord? Causes, Diagnosis, And Management

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A nuchal cord in pregnancy is a condition when the umbilical cord is wrapped around the baby’s neck. The umbilical cord connects the mother and baby and supplies oxygen and nutrients through blood vessels in it. However, an umbilical cord around the neck can prevent normal movement of the baby during delivery. In most cases, the nuchal cord in pregnancy is harmless. However, doctors may recommend C-section delivery if there is a concern that the cord may not slip over the baby’s head before vaginal delivery.

Read on to know the effects, diagnosis, and management of the nuchal cord during pregnancy and delivery.

What Is A Nuchal Cord?

Nuchal cord occurs when the umbilical cord wraps 360° around the fetal neck (1). It could be a single loop or multiple loops that can be loosely or tightly wrapped around the neck.

The nuchal cord is classified into:

  • Type A: Nuchal cord with a sliding pattern that can undo itself.
  • Type B: Nuchal cord with a locked pattern, making a true knot that cannot be undone without assistance.

Nuchal cords are common and are routinely checked for by the doctors during delivery.

How Common Is A Nuchal Cord?

Nuchal cord occurs in 10-29% of pregnancies. Its incidence increases as the pregnancy progresses – the incidence rate is around 12% at 24 to 26 weeks and increases to 37% at term (2) (3). As mentioned earlier, the nuchal cord is a common occurrence and not a cause of worry in most cases.

The next section lists out the various reasons for the occurrence of a nuchal cord. Keep reading.

What Causes A Nuchal Cord?

Regular movement of the baby in the womb is considered to be healthy. However, a rapid fetal movement could cause a nuchal cord. Other factors that could lead to a nuchal cord include (4):

Sometimes, nuchal cords can get wrapped tightly around the fetal neck and need to be manually untangled at the earliest after birth to prevent any complications.

Is It Possible To Detect A Nuchal Cord?

There are no noticeable symptoms in the case of a nuchal cord as it may not affect your body in any way. So, you may not know about it until any complication arises. But should you feel a sudden slowdown in the fetal movement, tell your doctor about it and get an ultrasound done to rule out any possibilities of cord entanglement.

Your doctor may also suggest other diagnostic procedures.

How is nuchal cord diagnosed?

A nuchal cord can be assessed through the following ways (3):

  • A combination of ultrasonography and color Doppler imaging can help identify 72% of single and 94% of multiple nuchal cords.
  • Also, the doctor may perform a transabdominal manual compression of the fetal neck to detect the nuchal cords before delivery. During the procedure, if the fetal heart rate drops, then the test ascertains the presence of nuchal cord.
  • Vibroacoustic stimulation is a non-invasive method used to detect a nuchal cord. It helps to identify the fetal heart rate deceleration, if any, at a particular frequency.

The section below tells you about the management of nuchal cord during labor.

How Is The Nuchal Cord Issue Addressed During Labor?

It is difficult to ascertain if the baby has a nuchal cord during labor. However, the doctors check for it when the baby’s head comes out first. If the loop is loosely held around the neck, it will easily slip over the head. If not, the doctors clamp and cut the cord before the baby’s shoulder is delivered.

Instead of cutting the cord, doctors might also do a somersault maneuver (rolling the mother’s feet over the head). This procedure involves somersaulting the baby’s head toward the mother’s thigh, while it emerges through the birthing canal and unwinding the cord immediately (8).

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Most of the times, the nuchal cord gets unwinded on its own before delivery. Its complications are very rare. However, early detection and timely management can make the process of delivery smooth without posing any risks to the baby.

Frequently Asked Questions

1. Is normal delivery possible with a nuchal cord?

Normal delivery is possible with a nuchal cord. The doctor may check if the cord is tightly or loosely wrapped during delivery. Based on the observation, they may unwrap the cord around the neck or cut it during delivery (12).

2. Can a nuchal cord cause autism?

Autism could be caused by genetic, environmental, or non-genetic factors (13). A meta-analysis study published in the National Library of Medicine has ruled out the nuchal cord as a potential risk factor for autism. However, more studies are required to confirm these findings (14).

A nuchal cord in pregnancy may restrict the baby’s normal movement during childbirth. It is not a serious cause of concern. Most cases involve a loosely wrapped umbilical cord that slips over the baby’s head during delivery, but a tight wrap may cause complications and require medical intervention. Ensure not to miss prenatal checkups and imaging crucial to detecting a nuchal cord as early diagnosis allows doctors to apply corrective measures. Focus on staying healthy and be observant of changes in fetal movements to reduce the risk of complications from a nuchal cord.

Key Pointers

  • When the umbilical cord gets wrapped around the fetal neck, it is called a nuchal cord.
  • Rapid fetal movement, extra-long umbilical cord, breech presentation of fetus, etc., could cause a nuchal cord.
  • A nuchal cord can be detected using ultrasonography and color Doppler imaging.
  • It usually unwinds on its own before delivery, but early discovery and proper care can make the delivery process smoother.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
1.J. D. Kemfang Ngowa, et al.; Nuchal Cord and Perinatal Outcome at the Yaounde General Hospital, Cameroon; Clinics in Mother and Child Health (2011)
2.Morarji Peesay; Cord around the neck syndrome; NCBI (2012)
3.Morarji Peesay; Nuchal cord and its implications; NCBI (2017)
4.What happens if the umbilical cord is around my baby’s neck?; The University of Texas Southwestern Medical Center
5.Preety Aggarwal, et al.; Cord entanglement in monochorionic monoamniotic twins: a case report; International Journal of Reproduction, Contraception, Obstetrics and Gynecology
6.Ultrasound determination of nuchal cord in breech presentation; American Journal of Obstetrics & Gynecology
7.Umbilical Cord Problems; Birth Injury Guide
8.Larry Reynolds; Practice Tips: ‘Somersault’ Maneuver For A Tight Umbilical Cord; Canadian Family PhysicianRhoades DA;
9. Risk factors and outcomes associated with nuchal cord. A population-based study; NCBI (1999)
10. Meconium Aspiration; Stanford Children’s Health
11.Apgar Scores; American Academy of Pediatrics
12.What happens if the umbilical cord is around my baby’s neck?UT Southwestern Medical Center.
13.What causes autism?Autism Speaks.
14. Ensiyeh Jenabi et al; Is fetal nuchal cord associated with autism spectrum disorder? A meta-analysis; National Library of Medicine.
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shreeja pillai

Shreeja holds a postgraduate degree in Chemistry and diploma in Drug Regulatory Affairs from the University of Mumbai. Before joining MomJunction, she worked as a research analyst with a leading multinational pharmaceutical company. Her interest in the field of medical research has developed her passion for writing research-based articles. As a writer, she aims at providing informative articles on health... more

Dr. Burcu Saygan Karamürsel

(MD)
Burcu Saygan Karamürsel is a board certified obstetrics - gynecology and maternal-fetal medicine specialist working in Ankara,Turkey. A graduate from Hacettepe University Medical School, she has also attended a fellowship programme at Bonn University Hospital, Perinatology Department. Currently, she runs her own private clinic in Ankara and contributes to several newspapers’ online health columns and websites. She is specialized in... more

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